Flushing Ports

Our facility does not have a standard of procedure written with flushing ports. Our pt. has a triple lumen subclavian. It has always been my practice to flush with 5cc NS and then 3CC of Heparin flush. Another RN says we can just do the Heparin since we are not using a fluid in between.

Our facility does not have a standard of procedure written with flushing ports. Our pt. has a triple lumen subclavian. It has always been my practice to flush with 5cc NS and then 3CC of Heparin flush. Another RN says we can just do the Heparin since we are not using a fluid in between.

Opinions? What does your policy and procedure state?

Thanks in advance.

night

When I worked at a larger hospital where we had a lot of triple lumens, the IV therapy woman told me that it was better to just flush with heparin. She said it was because of infection control and advised to only use saline if there was a med used.

Dec 17, '04

Our policy is to flush with saline followed by the heparin lock flush solution. I thought it was to be sure all the old Heparin gets flushed through and the catheter is 'flushed' (irrigated?) really well, as well as preventing mixing of other medications.

Maybe this is one of those things that will slowly make the rounds and we will all be skipping the saline (except between medications) in the years to come.

Dec 17, '04

In every facility I have been in we always flushed with just about 5cc of NS or about 3.33 cc's in each one since some nurses get lazy and only want to use 1, 10cc syringe :chuckle . Part of the logic behind that is we draw labs from the CVC's and most facilitys I have been in don't want you drawing PTT's PT's etc. from CVC's that have recently had heparin infused (although you can waste 10cc's of blood, pull out another 10cc's of blood for your CBC/BMB etc, then pull the blood for the PT/PTT after that and you should be okay, or at least that was the policy in most places I worked...your mileage may vary.

We didn't pull out the heparin until the line was occluded (which 99% of the time is because the last couple of shifts before never flushes the lines).

Dec 17, '04

In my facility, we flush ports with 10ml of normal saline followed by 100 units of heparin diluted to 5ml. We also must use 10ml syringes because of maintaining certain pressure levels in the lines.

Dec 18, '04

For CV line maintence, we flush all unused ports with 1 cc of 10 Unit/ml Heparin flush. After giving meds, we flush with 5 cc of NS before and after the med and use 1cc of 10 unit/ml Heparin flush. After lab draws, we flush with 10-20 cc of NS and 1cc of the Heparin flush. That is our current policy (unless it has changed since I've been on leave).

Dec 18, '04

I have a port and have had a over 2 years. I have it accessed twice a week so I am pretty used to the protocol used here. If a med or infusion is giving the port is first flushed with 10cc NS. Then med is given and then flushed with another 10cc NS and if that is all that is needed with the port it is then flushed with between 5-10cc heparin.

Each week I do have PT drawn. In this case the port is accessed. Flushed hard with 10cc NS then they pull back 10cc blood as the discard. Then place another syringe on for the actually blood drawing. After that it is again flushed with 10cc NS followed by 5-10cc heparin.

Take care. CurleySue

Dec 18, '04

In my facility we flush with NS only; frequent heparin flushes have been linked with HITTS (heparin-induced thrombocytopenia with thrombosis syndrome).

Dec 18, '04

Quote from KarafromPhilly

In my facility we flush with NS only; frequent heparin flushes have been linked with HITTS (heparin-induced thrombocytopenia with thrombosis syndrome).

I agree, we use just saline no reason to heperinize a pt.

Dec 18, '04

Quote from curleysue

I have a port and have had a over 2 years. I have it accessed twice a week so I am pretty used to the protocol used here. If a med or infusion is giving the port is first flushed with 10cc NS. Then med is given and then flushed with another 10cc NS and if that is all that is needed with the port it is then flushed with between 5-10cc heparin.

Each week I do have PT drawn. In this case the port is accessed. Flushed hard with 10cc NS then they pull back 10cc blood as the discard. Then place another syringe on for the actually blood drawing. After that it is again flushed with 10cc NS followed by 5-10cc heparin.

Take care. CurleySue

Do you mind me asking why you have a port???

Dec 18, '04

Quote from KarafromPhilly

In my facility we flush with NS only; frequent heparin flushes have been linked with HITTS (heparin-induced thrombocytopenia with thrombosis syndrome).

Agree. I was taught to flush lines with NS only. Between uses, lines are packed with 5000u/ml heparin, but not flushed with any heparin- this would cause the pt to be systemically heparinized.
The amount of the pack is 0.1cc over what the pack volume of the line is. For example: If the Art and Venous line pack volumes of a Split Ash are 2.0 and 2.1cc, you would pack with 2.1 and 2.2 cc (respectively) of 5000u/ml heparin. With pts whose lines clot frequently, you can get an order to pack with Activase (you must put special labels on the lines stating that they are packed with Activase -DO NOT FLUSH) if your facility allows it.

Dec 18, '04

This can be a little confusing folks, since not all ports are alike. Are you talking about a triple lumen, a broviac, a PICC, a midline catheter, an IVAD...you get my drift. Some require 2cc or 3cc or 5cc of heparin to maintain patency as a post flush. It depends on the device. PICCs definately require a 10cc syringe due to higher pressures exerted by smaller syringes...not good for PICCs (could rupture them). And there is a newer type of PICC that due to a new valve only is flushed with NS...no heparin at all. Use the SASH method with any of them, however, when giving meds (except these newer PICCs that I just mentioned). In the hospital, we flush q 8 hrs when not used. You really need to look at your facilities protocols for each. For these devices, there are usually protocols.

Dec 18, '04

This can be a little confusing folks, since not all ports are alike. Are you talking about a triple lumen, a broviac, a PICC, a midline catheter, an IVAD...you get my drift.